| NPI | 1982280426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WICKERSHAM Jr Member 908-309-5992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2021-03-25 |